Bruises and sprains

Bruises and sprains



Black and blue marks are often associated with bruises. A bruise, or contusion, appears on the skin due to trauma. Examples of trauma are a cut or a blow to an area of the body. The injury causes tiny blood vessels called capillaries to burst. Blood gets trapped below the skin’s surface, which causes a bruise.

Bruises can occur at any age. Some bruises appear with very little pain, and you might not notice them. While bruises are common, it’s important to know your treatment options and whether your condition warrants emergency medical attention.

Conditions that cause bruises, with pictures

Most bruises are caused by physical injury. Some underlying conditions may make bruising more common. Here are 16 possible causes of bruising.

Warning: Graphic images ahead.

Sport injuries

  • Sport injuries are those that occur during exercise or while participating in a sport.
  • They include broken bones, strains and sprains, dislocations, torn tendons, and muscle swelling.
  • Sport injuries may occur from trauma or overuse.


  • This is a mild traumatic brain injury that can occur after an impact to your head or after a whiplash-type injury.
  • Symptoms of a concussion vary depending on both the severity of the injury and the person injured.
  • Memory problems, confusion, drowsiness or feeling sluggish, dizziness, double vision or blurred vision, headache, nausea, vomiting, sensitivity to light or noise, balance problems, and slowed reaction to stimuli are some possible symptoms.
  • Symptoms may begin immediately, or they may not develop for hours, days, weeks, or even months following a head injury.

What different types of bruises are there?

There are three types of bruises based on their location on your body:

  • Subcutaneous bruises occur just beneath the skin.
  • Intramuscular bruises occur in the underlying muscles.
  • Periosteal bruises occur on the bones.

What are the symptoms and signs of bruises?

Symptoms of the bruise vary depending on the cause. Discoloration of the skin is often the first sign. While they’re usually black and blue, bruises can also be:

  • red
  • green
  • purple
  • brown
  • yellowish, which most often occurs as the bruise heals

You may also experience pain and tenderness in the area of bruising. These symptoms generally improve as the bruise heals.  

Severe symptoms

Other symptoms indicate a more severe condition. Seek medical attention if you have:

  • increased bruising while taking aspirin (Bayer) or other blood thinners
  • swelling and pain in the area of bruising
  • bruising that occurs after a hard blow or fall
  • bruising that occurs along with a suspected broken bone
  • bruising for no reason
  • bruising that fails to heal after four weeks
  • bruising under your nails that’s painful
  • bruising accompanied by bleeding from your gums, nose, or mouth
  • bruising accompanied by blood in your urine, stool, or eyes

Also, see a healthcare provider if you have:

  • unexplained bruising, especially in a recurring pattern
  • bruises that aren’t painful
  • bruises that reappear in the same area without injury
  • any black bruises on your legs

What causes bruises?

Unexplained bruises that appear on the shin or knee may come from bumping the area on a doorframe, bedframe, post, or chair without noticing.

Other common causes of bruises include:

  • sports injuries
  • car accidents
  • concussions
  • head injury
  • ankle sprain
  • muscle strain
  • blows, such as someone hitting you or being hit by a ball
  • medications that thin blood, such as aspirin or warfarin (Coumadin)
  • supplements

Bruises that develop after a cut, burn, fall, or injury are normal. It’s not uncommon to develop a knot in the area of bruising. These bruises form as part of your body’s natural healing process. In most cases, they’re nothing to worry about. However, if you have a wound that bruises, reopens, and produces pus, clear liquid, or blood, see a healthcare provider promptly. These can be signs of an infection.

If a child has unexplained bruising, take them to their healthcare provider to determine the cause. Unexplained bruising on a child can be a sign of serious illness or even abuse.

Certain medications also make it more likely for you to bruise. This is especially the case with blood thinners and corticosteroids. Some herbal supplements, such as fish oil, have similar blood-thinning effects and may lead to bruises. You may also notice bruising after receiving an injection or wearing tight clothing.

Bruises also tend to be more common in older adults. As you age, your skin becomes thinner, and the capillaries under your skin become more prone to breaking.

Some people bruise easily, with little impact to their body. Women are also more prone to bruising. In most cases, this is nothing to be alarmed about. However, if this is a recent development, talk to your healthcare provider about potential causes and treatment options.

Bleeding disorders

Sometimes bruising is caused by an underlying condition not related to injury. A number of bleeding disorders can cause frequent bruising. These conditions include:

  • Von Willebrand disease
  • hemophilia A
  • Christmas disease
  • factor VII deficiency
  • factor X deficiency
  • factor V deficiency
  • factor II deficiency

How to treat bruises

You may treat bruises at home with some of the following options:

  • Use an ice pack to reduce swelling. Wrap the pack in cloth to avoid putting it directly on your bruised skin. Leave the ice on your bruise for 15 minutes. Repeat this every hour as needed.
  • Rest the bruised area.
  • If practical, raise the bruised area above your heart to keep blood from settling into the bruised tissue.
  • Take an over-the-counter medication, such as acetaminophen (Tylenol), to reduce pain in the area. Avoid aspirin or ibuprofen as they may increase bleeding.
  • Wear tops with long sleeves and pants to protect bruises on your arms and legs.


A joint sprain is the overstretching or tearing of ligaments. Ligaments are the bands of tissue that connect two bones together in a joint. The most common location for a sprain is the ankle joint.

A joint strain is the overstretching or tearing of muscles or tendons. Tendons are the dense fibrous cords of tissue that connect bones to muscles. The most common locations for a muscle strain are the hamstring muscle and the lower back.

The symptoms of a sprain and a strain are very similar. That’s because the injuries themselves are very similar. It’s no wonder the two conditions are frequently confused.

Common symptoms of sprains

Common symptoms of strains

• bruising
• pain around the affected joint
• swelling
• limited flexibility
• difficulty using the joint’s full range of motion

• muscle spasm
• pain around the affected joint
• swelling
• limited flexibility
• difficulty using the joint’s full range of motion

The main difference is that with a sprain you may have bruising around the affected joint, whereas with a strain, you may have spasms in the affected muscle.


Our bodies work hard day after day, so an occasional strain or sprain isn’t uncommon. Certain situations make you more likely to injure your joints. These include:

  • athletic activities or exercise, including running or jogging
  • accidents, such as falling or slipping
  • lifting heavy objects
  • overexerting yourself
  • sitting or standing in an awkward position
  • prolonged repetitive motion

Risk factors

Anyone at any point can experience a sprain or strain, but certain risk factors increase your odds for overstretching a joint. These risk factors include:

  • Being out of shape. Lack of proper conditioning leaves your muscles and joints weak and unable to fully support your movements.
  • Using improper equipment. Equipment that is worn out or ill-fitting will increase your risk for a sprain or strain. It’s important you keep your shoes and any necessary gear maintained.
  • Not warming up. Warming up and cooling down after exercise or athletic activity helps you prevent injury. Warming up gently stretches the muscles and increases your range of motion. A cool down stretch helps strengthen your muscles for better joint support.
  • Being tired. When you’re tired, you don’t carry your body properly. Being tired means you’re less likely to practice good form. Schedule days off between exercise so your body can rest and heal.
  • Your environment.Wet, slippery, or icy surfaces are treacherous for walking. These aren’t risk factors you can control, but being aware of when they’re around will help you avoid an injury.


Doctors often diagnose a sprain or strain by excluding other causes for your symptoms. After a brief physical exam, your doctor may request an X-ray. An X-ray will rule out any breaks or fractures.

If the X-ray isn’t conclusive, your doctor might request another type of imaging test called an MRI. An MRI can give your doctor a very detailed view of the joint. An MRI might reveal very small or thin breaks that an X-ray can’t identify.

If neither the MRI nor X-ray reveals any breaks or injuries to the bone, your doctor will likely diagnose a sprain or strain.


Mild strains and mild sprains are treated with the same technique. This technique is known as RICE. RICE stands for:

  • Rest: Stay off the affected joint, or try not to use it while it heals. This will give the joint time to heal.
  • Ice: Ice helps reduce swelling and inflammation. Never apply ice directly to your skin. Instead, wrap a thin towel or piece of clothing around a bag of ice. Leave it on the affected area for 20 minutes, then remove the ice for 20 minutes. Repeat as much as you can for the first 24 to 48 hours.
  • Compression: Compression will help reduce the swelling. Wrap the affected joint in a bandage or trainer’s tape. Do not wrap too tightly, however, or you can reduce the blood supply.
  • Elevation: Try to keep the affected joint elevated above the level of your heart. This will help reduce swelling. If your knee or ankle is affected, that may mean you need to stay in bed or on the couch for up to two days after your injury. If you can’t keep it as high as your heart, parallel to the ground is also OK.

For the first 24 to 48 hours after your injury, RICE may make you more comfortable and reduce signs and symptoms.

More severe strains and sprains may require surgery to repair damaged or torn ligaments, tendons, or muscles. If you experience any of the following, see a doctor about your sprain or strain:

  • difficulty walking or standing without pain
  • inability to move or flex the affected joint
  • feeling numbness or tingling around the joint